Wisconsin Medicaid Disability

Wisconsin Medicaid is a program administered by the Department of Health Services that can provide health care benefits to certain persons with disabilities.

If you have not been determined disabled by the Social Security Administration, but you are disabled, you may apply for Medicaid benefits based on your disability. You may also apply for Medicaid if you have already applied for Social Security Disability Income or Supplemental Security Income and are waiting for a decision.

Note: If you are determined disabled by the Social Security Administration and receive Supplemental Security Income, you will automatically receive Medicaid benefits.

Applying for Medicaid Disability

To apply for Medicaid Disability, contact your local agency. The local agency will submit your Medicaid Disability application to the Department of Health Services, Disability Determination Bureau (DDB), who will make a disability determination.

The DDB may send you other forms that ask for more information about the jobs you have had or about your daily activities. It is your responsibility to complete and return these forms as soon as possible. This additional information is needed to complete your application.

If additional medical information is needed, the DDB may schedule a medical examination at no cost to you. It is your responsibility to attend the examination on time and on the date scheduled. If you do not attend any special examinations you are scheduled for or you do not furnish additional information requested, your application may be denied for insufficient evidence or information. The disability determination is based on medical and other information provided by your health care providers.

If after you complete the application and before your final decision you:

See any new providers,

Are scheduled for more medical tests, or

Are hospitalized,

contact the DDB as soon as possible. This information will be needed for your disability determination.

Enrollment Determination

You will receive a notice regarding your enrollment. If your application is denied, your notice will include your appeal rights.

Note: If you change your address or telephone number, contact the DDB as soon as possible.

Deceased Applicants

An applicant who has died may be able to get Medicaid coverage for services that occurred prior to his/her death.

Wisconsin Medicaid Presumptive Disability

If you have an urgent need for medical services, and will likely be determined to be disabled by the DDB, but have not yet been found disabled by the DDB, you may apply for Medicaid presumptive disability. If you are determined presumptively disabled, you will be able to receive Medicaid covered services, until you receive your final disability determination.

Under some circumstances, your local agency will be able to determine if you are able to get presumptive disability. A presumptive disability determination is not the final decision. All Medicaid disability applications must still be sent to the DDB for a final determination.

Requesting Determination for Multiple Program Benefits

In addition to Medicaid Disability, the DDB processes applications for Social Security Disability Insurance (SSDI) and Supplemental Security Income Disability (SSI). The disability requirements are the same for all three programs. If you are also applying for SSDI or SSI the DDB will try to process the application request at the same time.

Information provided in this document is general. To find out more detailed information regarding Medicaid Disability, contact your local agency.

The Department of Health Services is an equal opportunity employer and service provider. If you have a disability and need to access this information in an alternate format, or need it translated to a different language, please contact (608) 266-3356 or 1-888-701-1251 (TTY). All translation services are free of charge.